Back Pain: It’s Not Always Arthritis

Back pain is prevalent in adults, and most often its cause is nonspecific and benign. Imaging and interventions are not always helpful and they are generally expensive and low yield. However, in about 10% or fewer cases, a specific etiology is found. A patient history, physical examination, and testing are the methods for finding the cause. Back pain from malignancy must also be considered. Prolonged survival from better chemotherapy has increased the incidence of metastases to bone, especially the spine. Common sources of spinal metastases are cancers of the prostate, kidneys, thyroid, breast, and lungs. The primary treatment is to address the malignancy. Pain from spinal tumors can be treated with chemotherapy, radiotherapy, radiofrequency, or vertebral augmentation therapy. The chapter reviews the epidemiology of spinal cancer pain, evaluation of malignant spinal pain, and what the interventional pain physician can offer patients to alleviate their pain.